LifeLine Benefit & Low Cost Service Plan Application

By submitting this form, you acknowledge and agree to the following:

1. Service Plan Setup: Completing this form initiates the process of setting up a service plan for you based on the information provided.

2. Credit Verification: A credit verification will be performed to determine eligibility and approval for the requested benefits or services.

3. Accuracy of Information: All information provided must be truthful and accurate. Falsifying details or providing misleading information is strictly prohibited and may result in denial of services or legal action.

4. By entering your information, you consent for "Essential Connect", and any of its affiliate service providers to use automated technology but not limited to: texts, phone calls, prerecorded messages, email or digital technology to contact your at the number and email provided about "Essential Connect" offers which may or may not be directly related to this specific marketing campaign using other affiliate companies. This consent is not required to make a purchase.

By submitting this form, you confirm that you have read, understood, and agree to these terms.